Liver disease as main cause of death in HIV/Hep C coinfection

This month's Hepatology assesses the clinical progression of Hepatitis C virus-related chronic liver disease in HIV-infected patients.

Little is known about the natural history of liver disease in human immunodeficiency virus (HIV)/Hepatitis C virus-coinfected subjects under highly active antiretroviral therapy.

Dr Juan Pineda and colleagues from Spain obtained information about the mortality, the incidence of hepatic decompensations, and the predictors thereof in this population.

The research team conducted a multicenter cohort study in 1011 antiretroviral naïve, human immunodeficiency virus/Hepatitis C virus-coinfected patients.

The patients had started highly active antiretroviral therapy.

The researchers prospectively analyzed the time to the first hepatic decompensation and the survival of the patients.

43% of deaths were because of liver disease

Hepatology

The team found that after a median follow-up of 5 years, 6% of patients developed a hepatic decompensation and 7% died.

The researchers reported that 43% of those deaths were because of liver disease.

The factors independently associated with the occurrence of hepatic decompensations were age older than 33 years.

The team noted that female sex, and Centers for Disease Control stage C were also independently associated with hepatic decompensations.

A diagnosis of cirrhosis at baseline, and CD4 cell gain lower than 100/mm³ were associated with mortality due to liver failure.

Less than 60% of the follow-up with undetectable human immunodeficiency virus viral load., and older age were associated with mortality due to liver failure.

The team noted that lack of Hepatitis C virus therapy, and Hepatitis D virus coinfection was associated with liver failure mortality.

In addition, a diagnosis of cirrhosis at recruitment, hepatic encephalopathy, and lower CD4 cell gain were associated with mortality due to liver failure.

Dr Pineda's team concluded, "End-stage liver disease is the primary cause of death in human immunodeficiency virus/Hepatitis C virus-coinfected patients under highly active antiretroviral therapy."

"Higher increase of CD4 cell counts, lack of markers of serious liver disease and therapy against Hepatitis C virus are factors associated with better hepatic outcome."